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Billing guidance for infusion therapy codes 90780, 90781

APCs Weekly Monitor, January 14, 2005

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Billing guidance for infusion therapy codes 90780, 90781

Question: Our facility has two questions on how to bill for infusion therapy:

1.) If you have fluids running in both arms at the same time, can you bill for the additional hours from both arms? For example, does two hours of infusion in the right arm, plus two hours in the left arm, equal four hours, or just two?

2.) With two IVs running can you bill additional hours from start to finish of all the infusions? For example, the patient's left arm has Milrinone infusing and you have to start a second IV in the right arm to infuse the KCL bolus. The Milrinone finishes up at 2 p.m., but the KCL doesn't finish until 3 p.m. Can we bill until 3 p.m., or do we stop at 2 p.m.?

Answer: When a patient receives multiple infusions at different sites in the same encounter, the hospital should bill 90780 once for each site (whether the multiple sites are in multiple limbs or same limb), and should bill 90781 for subsequent hours (up to eight hours) for each site if needed.

Note: Do not use modifier -59. The example under section H of the Internet-Only Manual chapter 4, section 230.1 is incorrect, and will be corrected soon.

One unit of APC payment is made for all infusion services billed under 90780 in the encounter, regardless of how many times 90780 is reported.

When you administer multiple drugs through the same infusion back to back, you have administered one infusion and should bill for the one infusion based on the duration. One unit of APC payment is made for the infusions in the encounter.

Therefore, the answers to the above questions are as follows:

1.) Bill a total of four hours, using the following methodology:  90780 (first site, first hour, unit of one, $200); 90780 (second site, first hour, unit of one, $200), 90781 (first site, second hour, unit of one, $100); 90781 (second site, second hour, unit of one, $100).

Do not report modifier -59 with any charge line items or codes. Medicare will reimburse for the session; not the number of sites or hours. But it is important to report the information correctly with units to supply Medicare with data to construct 2007 payment rates.

2.)  Bill the total hours for each IV in each site; however, do not report modifier -59.

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